If you have your own practice, I am sure you have had the debate or the quiet moment of contemplation over whether you should have a professional medical billing team on your side. What are the pros and cons and is it worth the investment? Overall, would it lead to a more successful business?
Ultimately, it is in your best interest, your staff’s best interest, and more to the point – the patient’s to outsource. Here’s why:
Over the last 10 years healthcare has been changing at an alarming rate. Looking back to the late 90’s and early 2000’s many physicians were opening up their own offices. Even pathologists were incorporating as an LLC and forming their own identity, separate from that of the hospital or facility for which they performed services. However, now, if you look – many of those same professionals have closed their private doors and assimilated into the institutions for which they serve. Looking forward, with the ACA and what may come, healthcare will continue to evolve and change radically.
For those providers that still open their doors themselves, faithfully, every day, they are constantly working in a variety of situations. They are the kind and doting practitioner, the business savvy office director/entrepreneur, and the billing department. More than just their well-being depends on proper billing and collection. Providers hire and employ a wealth of other positions from nurses to medical assistants and office staff. The physician now becomes burdened with the weight of this responsibility. Sometimes, at night, they are up late entering information into the EHR, as time at the office could not be found – and without such information billing is not possible, nor would the physician be compliant with current standards.
There are many reasons to outsource and all of them should be evaluated, however in the context of keeping this relevant and simple – there are 5 patient centric reasons.
- PATIENT CARE
Professional billing allows for the practitioner to provide more attentive care and in turn increase patient satisfaction with his or her services. As the ACA has been introduced into the landscape of American healthcare, there is a new metric that is evaluated for reimbursement and decisions in medicine, and this is patient satisfaction. A professional billing team can increase the overall patient satisfaction, not only with the services rendered, but in other ways. This directly impacts the staff in the offices and their overall outlook and how they treat patients, small practices are often spread thin and this wears on the staff and how they treat clients. And again, for the tireless physician, perhaps he or she can gain back personal time in the evening by not spending it doing routine office and billing duties that did not get done during the day.
- ERRORS
Again, this relates back to overall patient care, where good practices begin and end. If billing errors are decreased or absolved then patient care and, one more time, patient satisfaction will go up. Imagine, not only the stress of having a denied claim or rejected claim from a patient standpoint, but the potential for a patient to see a wrong billing code for diagnosis. One that possibly the patient does not even suffer from? The will cause acute stress for both parties involved, yes, but could be devastating for the patient even more so – with anxiety, dread, and mistrust. One incorrect entry of a CPT code for reimbursement billing may severely alter an outcome, and unfortunately, payment as well.
- MONEY
Of course one of the advantages of a professional team that you’ve solicited is the fact that they can help you maximize the billing opportunities, by providing accurate and timely submittal of claims. In the long run remember it will directly impact the practice, by helping justify the right amount of FTE (full time employee) staff, overhead, and material management. Current statistics show that practices spend on average 27% of their revenue on administrative costs alone. The median salary of a medical billing professional is $34,727 as of February 22, 2017. When quantifying that across the average practice at 3 billers, and then adding overhead your annual cost of a billing team on average would be $145,853. A provider may save hundreds of thousands of dollars, not counting their personal time they regain, and consistent appropriate billing. Keep in mind, your practice’s team of in-house medical billers are compensated regardless of the time, effort and results they produce.
On the other hand, an out sourced team of medical billing experts are only compensated for the amount of money they collect on your behalf on a monthly basis. For this reason alone it is in the best interest of the medical billing company to ensure that your practice receives maximum effort and attention to detail which in turn will streamline your billing process and increase profitability exponentially.
- CASHFLOW
In the same vein, having a billing services team provides constant effective billing day in and day out. There isn’t the need to hold billing until staff returns from PTO or for any number of other obstacles you may face with an in house billing team. There are no interruptions to submit. You now have a team of billing professionals that act immediately and accordingly to provide your practice with unmatched customer service and a seamless billing process. The practice gets to eliminate costly time, resources, and heartache that go along with billing issues and errors. All the while, allowing for a steady flow of cash through the business.
- COMPLIANCE
One of the most difficult things with the new era of medicine is understanding the constant changes in the rules, regulations, and reimbursement mandates. The provider needs to look at how big his or her office is and the amount of staff that is required to run the office and ask him or herself, is it in the best interest of the practice to have staff train annually on billing/EHR? Every year CMS (Center for Medicare Services) introduces new releases and changes to the current billing standards. It is up to the billing specialists to understand how they affect providers and to master the new reimbursement regulations. There are new CPT codes, eliminated codes, and coupled codes. There are G codes for government insurance providers that are different from private insurers. Not to mention, the percentage changes in reimbursement rates, weather they raise or drop – has drastic effects on the individual provider. It is more than a light challenge. It is a strong benefit in just this category to have a professional in your corner, one that understands the new rules and submits claims correctly the first time.
While there are many factors an individual practitioner must consider, one of the more integral questions has become the subject of billing. Not only compliant and appropriate billing, but consistent as well, has become a dubious task in the recent years. Obviously there are many factors that decide if an outside form should be a part of the practice’s team, but in such an unpredictable and tumultuous future of healthcare – it almost begs the question how can it not be? Realize there are many more reasons than 5 or 10, but healthcare and insurances have changed, they are patient-centric, and complicated. And as a provider and a patient we owe each other our best, and to save us from the worst. Outsourcing may be the best way to do that, and regain some time outside of work – to deliver even better patient care.